第3代伽玛钉与ACE粗隆钉治疗股骨粗隆间骨折的比较  

Comparison of Gamma 3 nail and Ace trochanteric nail in treatment of intertrochanteric fractures

作　　者：刘敏波[1] 朱宝华[1] 王俊[1] 朱立华[1] 崔永锋[1] 

机构地区：[1]浙江省杭州市萧山区第一人民医院骨一科,311200

出　　处：《中华全科医学》2014年第4期557-559,共3页Chinese Journal of General Practice

摘　　要：目的分析比较第3代伽玛钉与ACE粗隆钉治疗老年患者股骨粗隆间骨折的手术安全性及疗效。方法收集2008年5月—2013年1月于杭州市萧山区第一人民医院收治96例股骨粗隆间骨折的老年患者，其中52例患者采用第3代伽玛钉治疗，44例患者采用ACE粗隆钉治疗。所有患者均在术后6周～1年间定期接受临床及影像学随访。结果2组患者的年龄、骨折类型及术前MerleD’Aubign6髋关节评分差异无统计学意义。第3代伽玛钉治疗组和ACE粗隆钉治疗组患者术后MerleD’Aubign6髋关节评分差异无统计学意义（13．23±2．71vs．14．35±2．87，P=0．24）。但术后第3代伽玛钉治疗组的评分较ACE粗隆钉治疗组有明显降低（2．80±0．86VS．0．84±0．53，P=0．002）。此外，ACE粗隆钉治疗组的平均手术时间与第3代伽玛钉治疗组的平均手术时间差异无统计学意义[（48．00±5．26）minVS．（51．00±4．47）min，P：0．07]。术后第3代伽玛钉治疗组有1例患者（1．9％）出现轻微周围神经损伤（足下垂）。2组均有2例患者出现内固定失败（3．8％VS．4．5％，P〉0．05）。术后1年与手术无关的总病死率为26％，2组分别为25％、27．3％（P〉0．05）。结论使用第3代伽玛钉与ACE粗隆钉治疗股骨粗隆间骨折均安全有效。Objective To compare the effect and safety of the Gamma 3 nail and ACE trochanteric nail for the intertro- chanteric fractures in elderly patients. Methods From May 2008 to January 2013,96 elderly patients with intertrochan- teric fractures were reviewed retrospectively. Among them,52 patients were treated with the Gamma 3 nail, and 44 patients with ACE trochanteric nail. All patients were followed-up by regular clinical and radiography 6 weeks to 1 year after sur- gery. Results The difference in age, type of fracture and preoperative Merle d＇ Aubigu6 hip score of both groups was not significant. There was no significant difference in Merle d＇ Aubign6 hip score of both groups（ 13.23 ± 2.71 vs. 14.35 ± 2.87,P = 0.24）. However,the postoperative score of gamma 3 nail significantly reduced more than that of ACE trochan- teric nail（2.80 ±0.86 vs. 0.84 ±0.53 ,P =0. 002）. In addition,the difference in the mean operative time of the Gamma 3 nail group and ACE trochanteric nail group was not significant（48.00 ±5.26 vs. 51.00 ±4.47 min,P =0.07）. The pe- ripheral nerve injury（ foot drop） oeeurred in 1 case（ 1.9% ） after surgery in the Gamma 3 nail group. The internal fixation failure occurred in both groups （ the Gamma 3 nail vs. ACE trochanteric nail, 3.8% vs. 4.5% , P 〉 0.05 ）. The overall mortality of 1 year after surgery not related to surgery was 26% , and the Gamma 3 nail group and ACE trochanteric nail group were 25% and 27.3% , respectively （P 〉 0.05 ）. Conclusion Both the Gamma 3 nail and ACE trochanteric nail are safe and effective in the treatment of intertrochanteric fractures.

关 键 词：股骨粗隆间骨折 内固定 第3代伽玛钉 ACE粗隆钉 

分 类 号：R683.42[医药卫生—骨科学] R687.32[医药卫生—外科学]